<div class="layuimini-container">
    <form id="app-form" class="layui-form layuimini-form">
        
        <div class="layui-form-item">
            <label class="layui-form-label">姓名</label>
            <div class="layui-input-block">
                <input type="text" name="name" class="layui-input" placeholder="请输入姓名" value="{$row.name|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">性别</label>
            <div class="layui-input-block">
                {foreach $getSexList as $k=>$v}
                <input type="radio" name="sex" value="{$k}" title="{$v}" {in name="k" value="$row.sex"}checked=""{/in}>
                {/foreach}
            </div>
        </div>

        <div class="layui-form-item">
            <label class="layui-form-label">身份证号</label>
            <div class="layui-input-block">
                <input type="text" name="id_card" class="layui-input" placeholder="请输入身份证号" value="{$row.id_card|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">手机号</label>
            <div class="layui-input-block">
                <input type="text" name="mobile" class="layui-input" placeholder="请输入手机号" value="{$row.mobile|default=''}">
            </div>
        </div>
        <div class="layui-form-item layui-form-text">
            <label class="layui-form-label">现居住地址</label>
            <div class="layui-input-block">
                <textarea name="living" class="layui-textarea" placeholder="请输入现居住地址">{$row.living|raw|default=''}</textarea>
            </div>
        </div>
        <div class="layui-form-item layui-form-text">
            <label class="layui-form-label">户籍所在地</label>
            <div class="layui-input-block">
                <textarea name="domicile" class="layui-textarea" placeholder="请输入户籍所在地">{$row.domicile|raw|default=''}</textarea>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">工作单位</label>
            <div class="layui-input-block">
                <input type="text" name="employer" class="layui-input" placeholder="请输入工作单位" value="{$row.employer|default=''}">
            </div>
        </div>
        <div class="layui-form-item layui-form-text">
            <label class="layui-form-label">出发地、路径地及时间</label>
            <div class="layui-input-block">
                <textarea name="buy_way" class="layui-textarea" placeholder="请输入出发地、路径地及时间">{$row.buy_way|raw|default=''}</textarea>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">到沙时间</label>
            <div class="layui-input-block">
                <input type="text" name="arrival_time" data-date="" data-date-type="datetime" class="layui-input"  placeholder="请输入到沙时间" value="{$row.arrival_time|default=''}">
            </div>
        </div>
        <div class="layui-form-item layui-form-text">
            <label class="layui-form-label">出发地</label>
            <div class="layui-input-block">
                <textarea name="departure" class="layui-textarea" placeholder="请输入出发地">{$row.departure|raw|default=''}</textarea>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">最近一次核酸检测时间</label>
            <div class="layui-input-block">
                <input type="text" name="check_time" data-date="" data-date-type="datetime" class="layui-input"  placeholder="请输入最近一次核酸检测时间" value="{$row.check_time|default=''}">
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">核酸检测结果</label>
            <div class="layui-input-block">
                {foreach $getCheckResultList as $k=>$v}
                <input type="radio" name="check_result" value="{$k}" title="{$v}" {in name="k" value="$row.check_result"}checked=""{/in}>
                {/foreach}
            </div>
        </div>

        {if $isSuper}
        <div class="layui-form-item">
            <label class="layui-form-label">居住地所属社区</label>
            <div class="layui-input-block">
                <select name="community">
                    {foreach $getCommunityList as $k=>$v}
                    <option value="{$v.id}" {in name="v.id" value="$row.community"} selected{/in}>{$v.name}</option>
                    {/foreach}
                </select>
            </div>
        </div>
        {/if}

        <div class="layui-form-item">
            <label class="layui-form-label">健康码</label>
            <div class="layui-input-block layuimini-upload">
                <input name="image1" class="layui-input layui-col-xs6"  placeholder="请上传健康码" value="{$row.image1|default=''}" readonly>
                <div class="layuimini-upload-btn">
                    <span><a class="layui-btn" data-upload="image1" data-upload-number="one" data-upload-exts="png|jpg|ico|jpeg" data-upload-icon="image"><i class="fa fa-upload"></i> 上传</a></span>
                </div>
            </div>
        </div>
        <div class="layui-form-item">
            <label class="layui-form-label">行程码</label>
            <div class="layui-input-block layuimini-upload">
                <input name="image2" class="layui-input layui-col-xs6"  placeholder="请上传行程码" value="{$row.image2|default=''}" readonly>
                <div class="layuimini-upload-btn">
                    <span><a class="layui-btn" data-upload="image2" data-upload-number="one" data-upload-exts="png|jpg|ico|jpeg" data-upload-icon="image"><i class="fa fa-upload"></i> 上传</a></span>
                </div>
            </div>
        </div>
        <div class="hr-line"></div>
        <div class="layui-form-item text-center">
            <button type="submit" class="layui-btn layui-btn-normal layui-btn-sm" lay-submit>确认</button>
            <button type="reset" class="layui-btn layui-btn-primary layui-btn-sm">重置</button>
        </div>

    </form>
</div>